How can I differentiate between septic and non-septic bursitis in a primary care setting?

To differentiate between septic bursitis and non-septic bursitis in a primary care setting, the key step is to perform bursal aspiration for fluid analysis. This allows for Gram staining and culture to confirm or exclude infection, which is fundamental to successful management.

Septic bursitis typically presents with signs of infection such as redness, warmth, swelling, and tenderness over the bursa, often accompanied by systemic signs like fever or malaise, especially in immunocompromised or systemically unwell patients.

Non-septic bursitis usually lacks systemic symptoms and presents with localized swelling and discomfort without signs of infection.

If aspiration is not possible in primary care due to lack of expertise, referral should be considered urgently.

Empirical antibiotic treatment should be started if septic bursitis is suspected, covering common organisms like Staphylococcus aureus, while awaiting culture results.

In contrast, non-septic bursitis is managed conservatively, and corticosteroid injections should only be considered after excluding infection by aspiration and culture.